In fast-paced clinical environments, informal “curbside consults” are often an invisible but essential part of patient care. A quick hallway question, a secure message, or a brief call between colleagues can help clinicians make decisions in real time — often without the delays associated with formal consultations.

But because care teams become more complex and the responsibilities of nurse practitioners (NPs), physician assistants (PAs), and nurses continue to expand, these informal exchanges are drawing closer scrutiny. While curbside consults can improve efficiency, some clinicians say they also raise important questions about scope of practice, liability, and patient safety — particularly when clinicians are asked to weigh in outside their specialty training.

Across hospital and outpatient settings, advanced practice clinicians describe curbside consults as both ubiquitous and, at times, uncomfortable. In some care environments, they may be especially ingrained in day-to-day operations.

“In long-term care settings, curbside consults are very common,” said Jamilla A. Campo, MSN, PMHNP-BC, psychiatric mental health NP who works across multiple facilities in New York State. “As a psychiatric nurse practitioner, I frequently receive quick questions from bedside nurses, nurse supervisors, social workers, and other clinicians during rounds, at nursing stations, in hallways, or by phone when staff are trying to interpret a sudden change in a resident’s behavior.”

At the same time, clinicians in other care models describe a different dynamic — one driven less by colleague-to-colleague requests and more by patients themselves.

“In my current practice setting, ‘curbside consults’ are not particularly common,” said Maggie Bell, RN, registered nurse and dietitian with more than a decade of experience in state agencies and private institutions, who now works with the online nutrition provider WOWMD. “However, it is fairly common for patients to ask physicians, nurse practitioners, nurses, or other healthcare professionals for advice about health concerns that fall outside the reason for their current visit.”

Efficiency and Access to Care

When used appropriately, curbside consults can offer clear benefits, and for some clinicians, those benefits are substantial.

“The positive impact of curbside consultation on efficiency and patient flow is significant,” said Gail Clifford, MD, MMM, CPE, medical consultant at Paramount Wellness Retreat in Haddam, Connecticut. “It helps prevent ‘consult fatigue’ among specialists and allows the primary team to maintain momentum.”

In high-volume settings, she said, these informal exchanges can help clinicians move forward without waiting 24-48 hours for a formal consult.

“The use of curbside consultations also allows for each advanced practice provider to troubleshoot quickly,” she said, “and ensures that there is no delay in the path of care for patients.”

Other clinicians echoed that curbside consults can help avoid unnecessary formal consults, reduce delays, and improve patient flow — particularly in busy hospitals and clinics.

Campo described how these interactions often serve an operational function in long-term care settings, helping teams determine the most appropriate next step.

“If I am on site, staff may hope the resident can be evaluated the same day,” she said. “If the situation is not urgent or documentation is incomplete, the issue may be addressed during my next scheduled visit. In more urgent situations, staff may request a telehealth evaluation.”

From a patient-facing perspective, Bell said informal guidance can also help clinicians triage care more effectively. However, she added that these interactions do not always improve efficiency and can sometimes disrupt workflow or patient schedules.

These consultations can take very different forms, as well. Bell described how informal consult dynamics in her setting are often driven by patient anxiety and access barriers.

“These situations often occur when a patient is being treated for one issue and another health concern arises that falls outside the clinician’s specialty,” she said. “The patient may be referred to a specialist but could face a wait of several weeks or months for an appointment. During that waiting period, patients sometimes seek informal guidance from clinicians they already have access to because they are anxious and want reassurance.”

In long-term care, meanwhile, Campo noted that many curbside consults center on behavioral changes in residents — situations where the underlying cause is not always immediately clear.

“The questions often involve medication concerns, refusal of care, or whether symptoms appear psychiatric or medical in nature,” she said. “In many facilities, behavioral changes are quickly escalated to psychiatric consults, but in long-term care environments, behaviors may reflect underlying medical distress such as infection, untreated pain, delirium, or medication side effects.”

The Limits of Informal Advice

At the same time, clinicians across settings emphasize that curbside consults have clear limitations and that those limitations can introduce risk. These experts noted that unlike formal consultations, curbside advice is typically based on secondhand information, without a full review of the patient’s history, examination, or complete diagnostic data, and that this can make it difficult to fully assess the situation or identify potential complications.

Clifford said she has one “key inflection point.”

“The boundary of risk for an inappropriate consultation lies at the point where high-stakes decision-making occurs, such as surgical vs medical decisions or life-changing diagnoses,” she said.

She said that there is also the risk for “cognitive closure” — a mental error in which a clinician prematurely accepts an informal suggestion as a definitive answer without a full workup.

“This risk is greatly increased when the convenience of a quick answer leads a provider to bypass the formal diagnostic process for a complex condition,” she said.

Campo said that it is especially important for NPs and PAs to stay top level with thoughts shared in a curbside consult.

“Without a full assessment or chart review, advice should remain general guidance rather than definitive clinical recommendations,” she said.

Bell said those concerns are high on her list and said informal guidance becomes problematic when clinicians operate outside their scope or without sufficient patient information.

Scope, Supervision, and Liability Concerns

Curbside consults also raise important questions about liability and scope of practice.

Because informal advice is often undocumented, it may be unclear who is ultimately responsible for clinical decisions. Clifford said that, in most cases, responsibility remains with the requesting provider. At the same time, she said that most healthcare systems have established collaborative practice agreements or standardized procedures that define the scope and supervision of NPs and PAs.

Bell added that scope-of-practice expectations are reinforced through state regulations and institutional policies, which emphasize practicing within defined boundaries and referring patients when specialized care is needed.

Disclosure information for Campo, Bell, and Clifford was not available at the time of publication.